Summary

Surgical interventions are only a small piece of the jigsaw puzzle for the successful management of patients with periodontal disease. In other words, even if executed using best practices and techniques, periodontal surgery procedures will not have a significant impact if they are not embedded in a practice environment that ensures that all the necessary phases of systematic periodontal treatment can be carried out in a competent manner.

This course does not dispense with the need to study the fundamentals of periodontology. However, the first part of this course module will teach you the most important theoretical aspects of establishing the structured approach needed for the systematic management of periodontal disease patients in private practice. Moreover, you will learn strategies for systematic treatment planning and indications for various periodontal surgical interventions required to achieve defined treatment goals according to established treatment concepts based on case studies in interactive work group discussions.

During these three days of training, you will focus on learning the microsurgical flap techniques needed, in particular, to perform regenerative periodontal surgery procedures. Intensive hands-on training with various training models and live surgeries will help you become skilled at planning and executing incision design, flap elevation, flap mobilization and flap stabilization techniques with a defect-specific approach. The skills learned in this course, up to an including the treatment of so-called hopeless teeth, will give you the foundation needed to manage patients with periodontal disease even more successfully in the future.

Contents

• Examination and diagnosis of patients with periodontal diseases
• Treatment planning protocols for patients with periodontal diseases
• Systematic periodontal therapy
• Surgical access therapy
• Regenerative periodontal therapy
• Max out periodontal therapy and hopeless teeth

Hands-on Training

• Treatment planning
• Microsurgical access flap
• Regenerative periodontal therapy for intrabony and class II furcation defects
• Decision-making in regenerative periodontal therapy

Live Surgeries

• Periodontal surgery I: Access therapy
• Periodontal surgery II: Regenerative therapy

Summary

Is there still room for resective periodontal procedures in the era of minimally invasive dentistry? The clear answer is: Yes, there is!

Within the scope of modern periodontal therapy, pocket elimination can still make sense in areas outside the esthetic zone if periodontal regeneration is not possible. Classical interventions like tunneling procedures, root amputation or hemisection have not died out but are still used to treat furcation-involved molars. In fact, not that it is becoming more and more evident that patients with a history of periodontitis have an increased risk of developing peri-implant diseases, these techniques are undergoing a renaissance and are more current than ever. Last but not least: up to date restorative dentistry would not be imaginable without resective periodontal surgery in situations where subgingival restoration margins cannot be managed by other methods. Fortunately, the radical approaches used in the 1960s and 1970s do not have much in common with the state-of-the art techniques performed today.

A contemporary approach to periodontal surgery with minimal damage to tissues and fibers will be the center of attention in these three days. Key elements include the sharing of important periodontal background knowledge and meticulous hands-on training.

Contents

• Indications and contemporary procedures
• Elimination of subgingival restoration margins
• Elimination of remaining pockets
• Treatment of furcation-involved molars
• Fiber retention technique

Hands-on Training

• Minimally invasive apically repositioned flaps I: Upper jaw – tuberoplasty
• Minimally invasive apically repositioned flaps II: Lower jaw – distal wedge technique
• Root resective periodontal surgery

Live Surgeries

• Minimally invasive apically repositioned flaps I: Upper jaw
• Minimally invasive apically repositioned flaps II: Lower jaw

Summary

Few innovations over the last 50 years have changed dentistry as much as the introduction of dental implants to replace lost or missing teeth. Modern dental treatment concepts without implants are hardly conceivable today. Still, it is becoming increasingly clear that implant dentistry will face major challenges in the next few years: Although reports of high medium-term survival rates initially made it appear that osseointegrated implants would remain in the patient's mouth for a lifetime in most cases, current cross-sectional studies have changed that outlook. A significant proportion of implant patients are clearly at risk of developing long-term biological complications in the form of peri-implant disease, including peri-implant mucositis and peri-implantitis. These are serious problems as hardly any predictable, scientific evidence-based, tried-and-tested treatments are currently available. Against this background, there appears to be an urgent need for extensive rethinking.

More than ever before, implant manufacturers are under enormous pressure to innovate in order to survive in a highly competitive market. The importance of critically scrutinizing supposed advances and innovations cannot be stressed enough, especially with regard to their possible long-term biological complications. Past research and training in implant dentistry often focused on technical aspects, such as cutting, drilling and screw insertion. In the future, it will be helpful to remember some of the benefits of past dental standards and practices while striving to develop sustainable strategies that ensure the complication-free management of dental implant patients so as to reliably prevent implant loss over the years, in spite of increasing life expectancy.

Another clear scientific trend today is that patient reviews are increasingly becoming the instrument by which medical interventions, treatment protocols, and treatment outcomes are rated, particularly in terms of morbidity and cost-benefit ratio. Although implant dentistry has had some success in recent years, there is still a lot of catching up to do. In particular, there is a need develop treatment protocols that result in fewer surgical procedures, shorter treatment times and less treatment complexity for the benefit of the patient.

Based on this premise, we will try to shine some light in the jungle of supposed advances in implantology in the scope of this course module. In interactive discussions and group activities, we examine the latest advances in implantology together with course participants in order to identify and discuss in detail those that can truly improve treatment outcomes in dental implant patients. These activities will focus on digital technologies and their potential to make dental implant treatment protocols safer, more predictable and, above all, simpler for patients.

The prevention, diagnosis and treatment of peri-implant diseases are the central themes of this three-day course. Based on the guiding principle of biologically driven implant placement, we will discuss clinical issues which, from today's perspective, must be taken into account in dental implant planning and treatment for optimal prevention of peri-implant diseases in the future. Participants will focus on learning surgical techniques for establishing sufficiently thick keratinized and fixed peri-implant mucosa in a wide range of clinical situations in well-supervised hands-on training exercises and live surgeries.

Contents

• Requirements for long-term success with implant-supported restorations
• Peri-implant disease: prevention, diagnosis and treatment of peri-implant lesions
• Composition of the peri-implant mucosa / impacts on peri-implant disease prevention
• Implant therapy and digital dentistry
• Current trends / implant patients and patient-reported outcome measures
• Timing of implant placement / immediate implant placement in the posterior dentition

Practical Training

• Implant uncovering in non-esthetic sites I: Increasing mucosal thickness
• Implant uncovering in non-esthetic sites II: Increasing the width of keratinized mucosa
• Immediate implant placement, immediate impressions and immediate provisionalization in the posterior dentition

Live Surgeries

• Implant uncovering in non-esthetic sites
• Immediate implant placement, immediate impressions and immediate provisionalization in the posterior dentition

Reconstructing soft-tissue defects in the esthetic zone is highly challenging for any clinician. For many years, the scientific and clinical development of suitable surgical techniques was measured in terms of achieving the best quantitative results possible. In the current view, however, it is impossible to obtain successful treatment outcomes if the best defect augmentation possible does not go hand-in-hand with good qualitative results in terms of color, surface texture and scar tissue. Therefore, even small shortcomings of the surgical procedure could lead to problems that can hardly be corrected later in many cases.

During these three days of training, course participants will further develop surgical skills learned in the previous modules. Theoretical and practical aspects of gingival recession management comprise the main course contents. Clinical experience in this field dates back several decades and is substantiated by an excellent base of scientific evidence. The previous training courses have given you the surgical skills and knowledge of biological principles underlying the treatment of gingival recession needed to ensure that you have a solid basis for performing more sophisticated techniques of soft-tissue reconstruction around teeth, implants and pontics presented in the more advanced modules.

Contents

• Oral soft-tissue esthetics – criteria and guidelines
• Soft tissue grafting – autografts and substitute biomaterials
• Gingival recession management

Practical Training

• Soft-tissue autograft harvesting from the anterior and posterior palate / single incision, trap door and distal wedge techniques
• Gingival recession management I: Modified coronally advanced flap
• Gingival recession management II: Modified coronally advanced tunnel flap
• Gingival recession management III: Double pedicle flap

Live Surgeries

• Gingival recession management I: Modified coronally advanced flap
• Gingival recession management II; Modified coronally advanced tunnel flap

The use of implants for tooth replacement in the esthetic zone is still an enormous challenge in practice. The clinician must consider a wide range of different concepts and approaches, not to mention the controversy and disagreement in the literature surrounding the overabundance of different macro and micro implant configurations and wide range of different hard and soft-tissue replacement materials for the maintenance and stabilization of peri-implant tissues. In particular, there still is no conclusive answer to the question of which treatment protocol is more predictable: immediate implant placement while preserving as much peri-implant tissue as possible or delayed implant placement with the best possible reconstruction of missing hard and soft-tissue structures. For the clinician, treatment decision-making for each individual patient’s case is often challenging, especially in view of the growing awareness that not only complete quantitative defect reconstruction but also qualitative esthetic results are key to achieving successful treatment outcomes.

This three-day seminar provides in-depth instruction in the essential scientific background information required to have the knowledge base needed to make the right decisions in the individual case for the benefit of your patients. Well-supervised hands-on training and carefully selected live surgeries will help you to effectively practice and internalize the essential clinical steps involved in immediate implant placement with alveolar ridge prophylaxis and in delayed or late implant placement with tissue reconstruction according to the current rules of practice.

Contents

• Biology and healing of extraction sockets
• Alveolar ridge preservation techniques
• Immediate implant placement
• Delayed implant placement
• Peri-implant soft-tissue deficiencies

Hands-on Training

• Delayed implant placement with hard and soft-tissue augmentation
• Implant uncovering with soft-tissue reconstruction

Live Surgeries

• Immediate implant placement with alveolar ridge preservation
• Delayed implant placement with hard and soft-tissue reconstruction
• Implant uncovering with soft-tissue reconstruction

Dental implant treatments can reach the limits of what is feasible for everyone involved in cases where tooth loss is associated with large-volume bone defects, especially in the vertical direction. Except for sinus floor elevation, most procedures for the surgical reconstruction of such hard-tissue defects have a relatively poor base of scientific evidence substantiating their predictability and long-term stability. Consequently, they are frequently associated with substantial morbidity for the affected patients. When these defects are located in highly esthetic areas, it is very rarely possible to achieve a truly predictable esthetic outcome. Last but not least, proper execution of the available surgical procedures requires a high level of manual dexterity on the part of the surgeon.

In this course module, we will therefore review the currently available literature together with the participants in order to identify procedures that satisfy today's requirements for successful bone reconstruction. In doing so, we will realistically define what each available procedure can actually be expected to achieve in specific indications as well as their weaknesses and limitations. During these three days of intensive and systematic training, you will focus on practicing these techniques on various training models. Live surgeries are also included to enable you to successfully carry out these procedures on your own patients directly after course completion.

Contents

• Bone healing and defect morphology
• Barriers, bone grafts and bone substitutes
• Sinus floor elevation with a lateral and crestal approach
• Bone augmentation procedures/ distraction osteogenesis, sandwich technique, cortical bone plate method
• Complication management

Hands-on Training

• Sinus floor elevation with a lateral approach
• Vertical bone augmentation with the cortical bone plate method

Live Surgeries

• Sinus floor elevation with a lateral approach
• Vertical bone augmentation with the cortical bone plate method

Periodontal and peri-implant surgical interventions are only small pieces of a comprehensive jigsaw puzzle when it comes to successfully addressing complex and individual patient demands in daily clinical routine. Managing the interfaces between periodontology and implant therapy as well as neighboring disciplines such as prosthetics, orthodontics, endodontic treatment, restorative dentistry and maxillofacial surgery is undoubtedly one of the biggest challenges in modern dentistry today.

For this reason, this module is dedicated to surgical procedures at the border to other dental disciplines, like orthodontic implant placement or gingival augmentation before and after orthodontic treatment, pontic site development or esthetic crown lengthening before prosthetic treatment or papilla reconstruction in combination with restorative dentistry. Furthermore, it will touch on important connections, for example, endo-perio lesions, gingival alignment and defect augmentation by orthodontic tooth movement, closure of black triangles with interdental composite restorations after periodontal therapy, prosthetic concepts in periodontally compromised dentitions and, most importantly, sustainable strategies during regular maintenance care. Last but not least, this course is about communication, timing, treatment planning and team-building as the final steps towards becoming a true master clinician in periodontology and implant dentistry.

Contents

• Orthodontic tooth movement in periodontally compromised patients
• Gingival augmentation before and after orthodontic treatment
• Ridge augmentation by orthodontic tooth movement
• Gingival alignment by orthodontic tooth movement
• Implants used for orthodontic anchorage
• Treatment of perio-endo lesions
• Esthetic crown lengthening
• Pontic site development
• Papilla reconstruction and restorative compensation of missing interdental tissues
• Synergistic cooperation with dental hygiene staff

Hands-on Training

• Comprehensive treatment planning
• Esthetic crown lengthening
• Surgical papilla reconstruction

Subjects:

• biology and healing of extraction sockets
• alveolar ridge preservation techniques
• immediate implant placement
• partial root retention – indications and case selection
• the socket-shield technique – clinical course of action
• complication management

Practical Trainings:

• decoronation, root preparation and partial extraction socket management
• computer-guided immediate implant placement with partial root retention
• immediate provisionalization

Live Surgeries:

• immediate implant placement with partial root retention and immediate provisionalization

Summary:

It appears to be fundamental, that over the past two decades a clear paradigm shift within health care towards patient-centered care could be noticed. Based on this premise, immediate implant placement with shorter treatment time, less treatment effort and fewer surgical interventions has gained increasing attention in the recent past. While the survival rates of immediately placed implants seem to be similar to implants inserted delayed or late, esthetic failures with midfacial and interproximal loss of soft tissue volume seem to be a common finding. To decrease the extent of soft tissue deficiencies in post-extraction sites, a variety of clinical recommendations as well as alveolar ridge preservation techniques have been described and investigated in the literature showing a significant reduction in vertical and horizontal defect formation following tooth extraction compared to unassisted socket healing. However, systematic literature reviews come invariably to the conclusion, that post-extraction resorption of the alveolar ridge might be limited, but cannot be completely avoided.

If therefore the target was, that in the future more implant patients can benefit from immediate implant placement, preventing loss of periodontal ligament and bundle bone after tooth removal would be key. In this connection “Root Retention” has currently attracted a renewed and increasing interest as “Root Submergence Technique” for pontic site development and as “Socket Shield Technique” for immediate implant placement. The underlying idea can be simply described as follows: if the root with its periodontal attachment apparatus is retained in the socket, the bundle bone can be preserved and consequently defect formation avoided. Under these circumstances predictable esthetic outcomes may be expected without any additional augmentation procedures and independent of the presence or dimension of the buccal bone plate. In addition to it, previously unattainable esthetic results may be derived in complex situations, in particular if more than one tooth next to each other needs to be replaced.

This two-day seminar provides in-depth instruction in the essential scientific background information to make the right decisions in the individual case for or against partial root retention. Well-supervised hands-on training and carefully selected live surgeries will help you to effectively practice and internalize the essential clinical steps involved in socket-shield interventions according to the currently developed rules of practice.

Dear friends of the Hürzeler/Zuhr Academy,

It is our great pleasure to announce the 2nd Hürzeler/Zuhr Academy Alumni Convention taking place in Spitzingsee from July 2nd to 4th 2020.

As you are used to, we will meet on Thursday at 2.00 pm in our premises at Rosenkavalierplatz 18 in Munich and will be back there on Saturday at 4.00 pm the latest.

Like last time, the meeting itself is not intended as a congress with a fixed sequence of theoretical lectures or practical hands on trainings. It's instead much more supposed to act as a tri-annual institutional event to network and exchange expertise among highly qualified professionals at eye level.

The three days will be shaped by interactive discussions under the heading of the overall topic „The Digital World of Dentistry - Interdisciplinary Approaches to Improve and Simplify Complex Treatment Processes“.

We are very proud that we were able to enlist Prof. Daniel Edelhoff, Head of the Prosthetic Department of the University of Munich and Prof. Björn Ludwig, orthodontist in private practice from Traben-Trarbach for the meeting. Both of them are proven and internationally accepted experts in the field of digital technologies and will be at their disposal with all their knowledge and all their experience over the complete timeframe.

Moreover, Marc and myself are planning to give you a short update of the latest scientific achievements and clinical innovations that influenced and changed our way to approach patients in the recent past. Some of you will be asked to present interesting patient cases for in-depth group discussions.

Last but not least there will be enough time for social activities, face to face conversation and in particular a lot of fun in a beautiful, inspiring and quiet environment in the heart of Bavaria.

It's all set - we are looking forward to seeing you again soon!